Selective destruction of the myenteric plexus: Its relation to Hirschsprung's disease, achalasia of the esophagus and hypertrophic pyloric stenosis

Summary In an attempt to study the role of the myenteric plexus in Hirschsprung's disease, pyloric stenosis and achalasia of esophagus, a selective destructive lesion of the intramural ganglia has been experimentally produced in the respective parts of the gut by perfusion with Tyrode's solution containing 0.002 per cent of mercuric chloride. A nonorganic stenosis accompanied by proximal dilatation and muscular hypertrophy was successfully produced in these three areas. The mechanism of stenosis appears to be a tonic contraction of the smooth muscle. The induced functional stenosis of the lower esophagus and the distal colon of the dog appeared in all respects to be identical physiologically to that seen in achalasia and Hirschsprung's disease in patients. Destruction of the myenteric plexus of the pylorus has produced similar functional stenosis in the pyloric region, but failed to produce the muscular tumor characteristic of the infant with congenital hypertrophic pyloric stenosis. Vagotomy has been carried out in a group of dogs for comparative study. Symptoms which mimic achalasia were produced, but motility studies have revealed it to be a reverse phenomenon, namely, an atonic dilatation of the whole esophagus.